Skip to main content
NCBI home page
British Journal of Experimental Pathology logoLink to British Journal of Experimental Pathology
. 1970 Apr;51(2):149–170.

Hypertension and Acute Rejection Processes in Allotransplanted Kidneys

W J Dempster
PMCID: PMC2072232  PMID: 4911958

Abstract

Once increased fluid leakage from the vessels of an allotransplanted kidney starts to raise the renal extravascular pressure, certain haemodynamic consequences follow unless further leakage or a comparable rate of leakage is prevented and the most significant of these is renal afferent vasoconstriction. The changes within the allotransplanted kidney leading to the onset of vaso-constriction are described.

The leakage of increased fluid through the renal microcirculation is immediate and is the first sign of the impact on an allotransplanted kidney of a foreign circulation. The increased leakage of fluid is akin to that which occurs during a subacute inflammatory reaction, i.e. an immediate hypersensitivity reaction. The cause is obscure, it does not appear to be related in the very beginning to cell invasion although later on leakage of fluid is accentuated by physical damage to the vessel walls incurred by cellular migration. It is relieved to some extent and particularly in the human, by large doses of steroid and represents the immediate and perhaps fundamental, aspect of the immunological response because it is unrelieved by lethal total body X-irradiation of the dog and some humans. There is some evidence, on the other hand, that local X-irradiation of a rejecting human allotransplanted kidney evokes a response and aids in reversing a rejection episode.

The physical and haemodynamic state of an acutely rejecting allotransplanted kidney can be simulated by physical means involving partial renal vein constriction. It is suggested that the rejection process can be analysed in terms of these physical alterations which can be reversed by releasing the causative physical factors involved. A comparative analysis of the consequences of these physical alterations goes some way to explaining the relative ease with which reversal of rejection can be effected in the human but rarely in the canine kidney by high dosage steroids. The analysis reveals the complexity of the hypertension which usually accompanies the rejection of kidney allotransplants. It is possible that yet another unknown hypertension-promoting mechanism is involved unless, on the other hand, a supposed renal hypotension-promoting mechanism is inhibited in the course of rejection.

Full text

PDF
149

Images in this article

160-1Figs. 2-6
on p.160-1
160-5Figs. 7-8
on p.160-5
160-3Fig. 6
on p.160-3

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almgård L. E., Granberg P. O., Lagergren C., Ljungqvist A. Arteriovenous anastomoses in the canine renal allograft. Nephron. 1966;3(5):295–308. doi: 10.1159/000179545. [DOI] [PubMed] [Google Scholar]
  2. BRODY M. J., FISCHER H. W. ANGIOGRAPHIC ANALYSIS OF RENAL VASOCONSTRICTION. Am J Physiol. 1964 Aug;207:495–499. doi: 10.1152/ajplegacy.1964.207.2.495. [DOI] [PubMed] [Google Scholar]
  3. Blaufox M. D., Birbari A. E., Hickler R. B., Merrill J. P. Peripheral plasma renin activity in renal-homotransplant recipients. N Engl J Med. 1966 Nov 24;275(21):1165–1168. doi: 10.1056/NEJM196611242752105. [DOI] [PubMed] [Google Scholar]
  4. Britton K. E. Renin and renal autoregulation. Lancet. 1968 Aug 10;2(7563):329–333. doi: 10.1016/s0140-6736(68)90534-5. [DOI] [PubMed] [Google Scholar]
  5. Brown T. C., Davis J. O., Olichney M. J., Johnston C. I. Relation of plasma renin to sodium balance and arterial pressure in experimental renal hypertension. Circ Res. 1966 May;18(5):475–483. doi: 10.1161/01.res.18.5.475. [DOI] [PubMed] [Google Scholar]
  6. Bunag R. D., Page I. H., McCubbin J. W. Influence of dietary sodium on stimuli causing renin release. Am J Physiol. 1966 Dec;211(6):1383–1386. doi: 10.1152/ajplegacy.1966.211.6.1383. [DOI] [PubMed] [Google Scholar]
  7. DEMPSTER W. J., HARRISON C. V., SHACKMAN R. REJECTION PROCESSES IN HUMAN HOMOTRANSPLANTED KIDNEYS. Br Med J. 1964 Oct 17;2(5415):969–976. doi: 10.1136/bmj.2.5415.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DEMPSTER W. J., JOEKES A. M., OECONOMOS N. The function of kidneys autotransplanted to the iliac vessels. Ann R Coll Surg Engl. 1955 May;16(5):324–336. [PMC free article] [PubMed] [Google Scholar]
  9. DEMPSTER W. J. Observations on the behaviour of the transplanted kidney in dogs. Ann R Coll Surg Engl. 1950 Oct;7(4):275–302. [PMC free article] [PubMed] [Google Scholar]
  10. EL ASFOURY Z. M. Sympathectomy and the innervation of the kidney. Br Med J. 1951 Dec 1;2(4743):1304–1306. doi: 10.1136/bmj.2.4743.1304. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Guttmann R. D., Lindquist R. R., Parker R. M., Carpenter C. B., Merrill J. P. Renal transplantation in the inbred rat. I. Morphologic, immunologic, and functional alterations during acute rejection. Transplantation. 1967 Jul;5(4):668–681. doi: 10.1097/00007890-196707000-00010. [DOI] [PubMed] [Google Scholar]
  12. HADDY F. J. Effect of elevation of intraluminal pressure on renal vascular resistance. Circ Res. 1956 Nov;4(6):659–663. doi: 10.1161/01.res.4.6.659. [DOI] [PubMed] [Google Scholar]
  13. Henry W. L., Kountz S. L., Cohn R., Robison S. L., Harrison D. C. Changes in pulsatile blood flow in autograft and homograft kidneys during rejection. Transplantation. 1969 Jun;7(6):545–553. doi: 10.1097/00007890-196906000-00010. [DOI] [PubMed] [Google Scholar]
  14. JACKSON B. T., MANNICK J. A. SERIAL BLOOD FLOW IN FIRST SET RENAL HOMOTRANSPLANTS UNDERGOING REJECTION. Surg Gynecol Obstet. 1964 Dec;119:1265–1270. [PubMed] [Google Scholar]
  15. JANIGAN D. T., WILLIAMS M. A., TYLER H. M., DEMPSTER W. J. A BIOCHEMICAL APPROACH TO THE STUDY OF REJECTION OF CANINE RENAL HOMOTRANSPLANTS. 3. HISTOCHEMICAL STUDIES OF TRANSPLANTED KIDNEYS. Br J Exp Pathol. 1964 Aug;45:347–356. [PMC free article] [PubMed] [Google Scholar]
  16. KOUNTZ S. L., WILLIAMS M. A., WILLIAMS P. L., KAPROS C., DEMPSTER W. J. MECHANISM OF REJECTION OF HOMOTRANSPLANTED KIDNEYS. Nature. 1963 Jul 20;199:257–260. doi: 10.1038/199257a0. [DOI] [PubMed] [Google Scholar]
  17. LLOYD T. C., Jr EFFECT OF ALVEOLAR HYPOXIA ON PULMONARY VASCULAR RESISTANCE. J Appl Physiol. 1964 Nov;19:1086–1094. doi: 10.1152/jappl.1964.19.6.1086. [DOI] [PubMed] [Google Scholar]
  18. Lindquist R. R., Guttmann R. D., Merrill J. P., Dammin G. J. Human renal allografts. Interpretation of morphologic and immunohistochemical observations. Am J Pathol. 1968 Nov;53(5):851–881. [PMC free article] [PubMed] [Google Scholar]
  19. Maebashi M., Miura Y., Yoshinaga K. Renin inhibitor in plasma of uraemic patients. Lancet. 1968 Jun 29;1(7557):1408–1409. doi: 10.1016/s0140-6736(68)91980-6. [DOI] [PubMed] [Google Scholar]
  20. Many M., Soroff H. S., Birtwell W. C., Giron F., Wise H., Deterling R. A., Jr The physiologic role of pulsatile and nonpulsatile blood flow. II. Effects on renal function. Arch Surg. 1967 Nov;95(5):762–767. doi: 10.1001/archsurg.1967.01330170070009. [DOI] [PubMed] [Google Scholar]
  21. Milgrom F., Litvak B. I., Kano K., Witebsky E. Humoral antibodies in renal homograft. JAMA. 1966 Oct 17;198(3):226–230. [PubMed] [Google Scholar]
  22. PEART W. S. Renin and hypertensin. Ergeb Physiol. 1959;50:409–432. [PubMed] [Google Scholar]
  23. PORTER K. A., JOSEPH N. H., RENDALL J. M., STOLINSKI C., HOEHN R. J., CALNE R. Y. THE ROLE OF LYMPHOCYTES IN THE REJECTION OF CANINE RENAL HOMOTRANSPLANTS. Lab Invest. 1964 Sep;13:1080–1098. [PubMed] [Google Scholar]
  24. Paccione F., Enein A. A., Shikata T., Dempster W. J. Changes in the transplanted ureter. Br J Exp Pathol. 1965 Oct;46(5):519–529. [PMC free article] [PubMed] [Google Scholar]
  25. Pate J. W., Estes J. W. Effects of elevated venous pressures on kidney function. Am Surg. 1968 Oct;34(10):729–735. [PubMed] [Google Scholar]
  26. Rosen S. M., Truniger B. P., Kriek H. R., Murray J. E., Merrill J. P. Intrarenal distribution of blood flow in the transplanted dog kidney: effect of denervation and rejection. J Clin Invest. 1967 Jul;46(7):1239–1253. doi: 10.1172/JCI105617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. SELKURT E. E., ELPERS M. J., WOMACK I. EFFECTS OF RENAL VENOUS OCCLUSION ON RENAL HEMODYNAMICS AND CONCENTRATING ABILITY. Am J Physiol. 1964 Nov;207:989–997. doi: 10.1152/ajplegacy.1964.207.5.989. [DOI] [PubMed] [Google Scholar]
  28. THURAU K. RENAL HEMODYNAMICS. Am J Med. 1964 May;36:698–719. doi: 10.1016/0002-9343(64)90181-0. [DOI] [PubMed] [Google Scholar]
  29. TYLER H. M., CHEESE I. A., STRUTHERS N. W., DEMPSTER W. J. A humoral change accompanying homograft rejection. Lancet. 1962 Sep 1;2(7253):432–434. doi: 10.1016/s0140-6736(62)90284-2. [DOI] [PubMed] [Google Scholar]
  30. VANDER A. J., MILLER R. CONTROL OF RENIN SECRETION IN THE ANESTHETIZED DOG. Am J Physiol. 1964 Sep;207:537–546. doi: 10.1152/ajplegacy.1964.207.3.537. [DOI] [PubMed] [Google Scholar]
  31. WAUGH W. H. Myogenic nature of autoregulation of renal flow in the absence of blood corpuscles. Circ Res. 1958 May;6(3):363–372. [PubMed] [Google Scholar]
  32. West T. H., Turcotte J. G., Vander A. Plasma renin activity, sodium balance, and hypertension in a group of renal transplant recipients. J Lab Clin Med. 1969 Apr;73(4):564–573. [PubMed] [Google Scholar]
  33. Wiener J., Lattes R. G., Pearl J. S. Vascular permeability and leukocyte emigration in allograft rejection. Am J Pathol. 1969 Jun;55(3):295–327. [PMC free article] [PubMed] [Google Scholar]
  34. Willoughby D. A. Mediators of the inflammatory response and their modification by therapeutic agents. Proc R Soc Med. 1967 Aug;60(8):775–778. [PMC free article] [PubMed] [Google Scholar]
  35. Wilson R. F., Fisher R. R. The hemodynamic effects of massive steroids in clinical shock. Surg Gynecol Obstet. 1968 Oct;127(4):769–776. [PubMed] [Google Scholar]

Articles from British Journal of Experimental Pathology are provided here courtesy of Wiley

RESOURCES